Need help developing hospital wide policy, procedures & protocols

Fonenurse · Jan 9, 2006

These sites may or may not be of use to you. I have sent them to you by email also

http://www.prodigy.nhs.uk/indexMain.asp

http://libraries.nelh.nhs.uk/guidelinesFinder/

http://www.nhsplus.nhs.uk/clinical-guidelines/roles.asp

Best wishes

globalnurse · Jan 11, 2006

Fonenurse... thanks for the post. appreciate it. have had a few responses by email and have followed up with several leads. a few other good sites have included: http://www.unchealthcare.org for a full range of nursing practice manuals, protocols and procedures

http://www.apic.org was ideal for infection control policies and procedures

http://www.healthsystem.virginia.edu/internet/infection-control/ic-manual.cfm also useful infection control policies & procedures

http://www.ha.org.hk also very useful infection control policies & procedures which also has some english/chinese translations (since being for a healthcare provider group in HK

these are just some of what i have found thus far.

i'm still after a Hospital Administration Manual (also known as a Manual of Hospital Administration), also a Manchester Triage Algorithms and a set of Emergency Procedure Flipcards... "code red for fire, code black for bomb threat etc, code blue for heart attack etc..."

globalnurse · Apr 15, 2006

anyone else come across some worthwhile sites or have access to some other resources? im progressing along slowly, but having to rely on an assistant to translate medico/legal policy, protocols and procedures, from english -chinese sure is a long battle... especially when they have no foundation in medicine/nursing. :S

to translate the infection control policy has taken around two months for around 20 pages of text. not withstanding expecting the current chinese infection control policy already in place to be translated chinese - english.

sigh... i might have to re-evaluate the 8-10yr time line i put on this one...

Trauma Columnist · Apr 15, 2006

Wow - what a wonderful opportunity you have! I would use some information from the Emergency Nurses Association for your ER:

http://www.ena.org

They have a big website with much information.

May I ask how you got into this venture? I gather you speak Chinese fluently? Are you from the US, NZ, Europe? Just very curious and think you are poised to make a huge impact in Chinese medicine.

NephroBSN, BSN, RN · Apr 15, 2006

Allow me to introduce myself.
I'm an RN, BN., BHSc., TNNC., ACLS., with ER specialty. For the past 3 years I have been employed in China, specifically Shanghai, where I was involved with a Sino/USA Joint Venture Hospital as a consultant. Part of my role required me to be heavily involved in updating and adaptation of the various Protocols, Policies & Procedures already in place as part of an overall review to prepare for eventual JCI accreditation. As well I undertook many new initiatives during my tenure; e.g. change management, conflict resolution, QI, through to reviewing/redesigning forms used, and wording in legal documents related to all aspects of the Hospital etc.
Last year I went of Saudi Arabia and worked with Saudi ARAMCO Petroleum & their RAC Project, which involved Emergency Pre-Hospital care. While there I worked on various aspects of the project at various levels and was involved with JCI.
I have returned to China and have recently taken up a consultative role within a Chinese Hospital (350 beds) based in the Ningbo Development Zone, some 30km from Ningbo City (A major deepwater port servicing the city of Shanghai, around 300km to the North).
I'm somewhat flabbergasted that the Hospital is without many Standardised Policies, Procedures & Protocols, and as such I have an enormous task developing the very same. The Hospital itself has undergone a major transition from being a Public Hospital, to being sold to a private individual [a TCM Dr. who has a dream to build a chain of Hospitals to International Standards] as you might imagine this is a "test model" for the government to remove itself from the primary delivery of Hospitalised based healthcare, so there are many eyes watching this new initiative at both a local and central government level). The owner is wanting to upgrade the Hospital from providing services of a domestic standard to that of an international standard with applicable accreditation i.e. JCI (He's realistic and knows this is going to be more like a 10yr plan).
It's even more complex as Guanxi (a poorly understood Chinese concept to most of us foreigners) plays a very significant part in the overall planning and implementation of all aspects of the Hospital (too in-depth to even discuss here).
Now however I'm just concerned at developing Hospital Policy & Procedure Manuals for all depts., and adapting them in a way which is workable in this setting, China is not the USA, EU, UK, and NZ or elsewhere, so there is a fair amount of adaptation involved.
Also adding to this complicated mix, is the opening of a new ICU, which doesn't really meet with recognised best practice standards, particularly in-relation to design and construction, but as I'm told is far better than what was in existence only a few years ago. The problem is that these critical patients were being cared for in standard wards, the argument used to open the ICU (as I had been against doing so, as were a few Dr's), while it would be prudent to transfer patients to other facilities, its just not that possible in the Chinese system as every hospital is too concerned with profitability & reputation.
Yes it's safe to say that nearly every hospital facility works independently, and there are no memorandums of understanding or good faith agreements for co-located sharing of care. This means in real terms very few Hospitals work co-operatively, as each is very protective of the earning potential from each patient, inter-hospital transfers just really don't happen here. This also applies as much inside Hospitals as each dept., attempts to reach fiscal targets and thereby obtain bonus rewards for the dept., and the staff. Therefore it means that few patients are transferred intra-hospitally and I'm sure this must impact the standard of care. This is another undertaking that will require a great deal of effort and patience to change.
Still the staff are extremely keen to be doing everything right, and inline with international based best practice. (do I note the sound of sarcasm in what I write?) Getting back to the ICU, it is missing a few vital elements that would otherwise make it a perfect fit in any facility, so I've impressed upon all and sundry for the need for being methodical and to be even more vigilant in the use of standard/universal precautions at a very minimum, in the interim.
One more thing, this Hospital has 350 inpatient beds and will begin construction of a new in-patient facility which will add another 800 beds in the next 2-3yrs, part of the reason there was some reluctance to spend more money on the ICU. There is currently a workforce of around 330, though like most places we're short of RN's, amongst other key employment groups.
Although there are some procedures in place, they are no where near the style, format or as in-depth and as well written as is found in Hospital facilities overseas. Added to this mix is my assistant who handles all my translating and interpreting, while she has great general translation skills and ability, she has no medical background and is not able to articulate well in this area. My preference is to start with a complete set of internationally acceptable hospital wide Policy, Procedures & Protocols that can then be translated from English into Chinese and not the other way round.
So after all this long winded post is about getting help, any help with policies and procedures which would be gratefully received, no matter if they are slightly outdated, so long as they utilise best practice methodologies, or are adaptable to the same.
If anyone can assist, please let me know or direct me to any suitable website where I can dig out Hospital Policy, Procedures and Protocols. Something, anything has got to be better than nothing.
Email me direct: dennis.middletonATgmail.com (replace AT with @ this is to stop automated spam)
With much thanks,
Dennis
Footnote:
This hospital has 350 beds and offers the following in/outpatient services (NB. there are a range of visiting specialists/professors who also offer weekly in/outpatient services at this facility);
1. Anesthesiology 麻醉科（ma zui ke ）
2. Biochemistry [Lab] 检验科 ( jian yan ke )
3. Cardiovascular 心血管科 (xin xue guan ke )
4. Dermatology 皮肤科 (pi fu ke )
5. Colonoscopy & Endoscopy 内窥镜室 ( nei kui jing shi )
6. Endocrinology 内分泌科 (nei fen mi ke )
7. ENT (Ear, Nose & Throat) 五官科 (wu guan ke )
8. Emergency 急诊 (ji zhen )
9. Gastroenterology 消化科 ( xiao hua ke )
10. ICU
11. Internal Medicine 内科 (nei ke )
12. Immunology [Lab] 免疫 (mian yi )
13. Neurology 神经内科 (shen jing nei ke )
14. Neurosurgical 神经外科 (shen jing wai ke )
15. OB/GYN 妇产科 (fu chan ke )
16. Ophthalmology (Eye) 眼科 ( yan ke )
17. ORL (Dental) 口腔科 ( kou qiang ke )
18. Orthopedic 骨科 (gu ke )
19. Outpatient Dept. comprising; 门诊包括：
* Internal Medicine 内科 (nei ke )
* Orthopedic 骨科 (gu ke )
* Pediatric 儿科 (er ke )
* Gastroenterology 消化科 (xiao hua ke )
* Liver & Gallbladder 肝胆外科 ( gan dan wai ke )
* Psychiatry 心理科 ( xin li ke )
20. Pediatric 小儿科 ( xiao er ke )
21. Physical Check/Assessment (Medical Assessment) 体检中心 (ti jian zhong xin )
22. Radiology (CT, DSA, MRI, Ultrasound, X-Ray) 放射科 ( fang she ke )
23. Rehabilitation 康复科 ( kang fu ke )
24. Renal 肾科 ( shen ke )
25. Respiratory 呼吸科 ( hu xi ke )
26. Surgical (General/Emergent) 外科 ( wai ke )
27. TCM/CTM (Chinese Traditional Medicine) 中医科 ( zhong yi ke )
28. Urology [surgical] 泌尿科 ( mi niao ke )

Aren't SA hospitals held to JCAHO standards or the Canadia standards? If you've been to SA and worked there wouldn't their P&P's be a good resourse.

As an aside, and not to change the subject, is China doing Hemodialysis? You may PM me so as not to clutter up this thread if you want.

More of a curiousity than anything.

Good luck. Seems like you have a hugmegous task ahead of you.

globalnurse · Apr 15, 2006

Wow - what a wonderful opportunity you have! I would use some information from the Emergency Nurses Association for your ER:
http://www.ena.org
They have a big website with much information.
May I ask how you got into this venture? I gather you speak Chinese fluently? Are you from the US, NZ, Europe? Just very curious and think you are poised to make a huge impact in Chinese medicine.

hi there :)

thanks for the link and comments 'preciate it

as to your question... it goes something like this... i started out as a graphic designer, then became a firefighter and after 7yrs in the 'service' and having risin thru the ranks, becoming one of the youngest officers (note i said one of) i did my ambulance quals and was on the corresponder program, which is a little like the fire/EMT program quite widespread thru the U.S. (i had a heavy background in surf lifesaving being a lifeguard, a instructor then examiner and having started my BN which i had to try and get finished after a 3yr break between i ended up moving into the ambulance service fulltime so i could better align my BN with my full time career.

eventually i finished my BN, left the services and settled into emergency nursing after doing my grad year in australia in general med and surg in a smaller regional hospital before moving round aussie working in emergency depts all over. then i traveled to china (had been to many asian countries before over the years), and landed a position with a sino-usa jv hospital... then went off to saudi before returning then landing this consultancy position.

this position covers everything... and then some. when i first arrived they were just about to sign off on the architects design, albeit my arrival... a self taught crash course in autoCAD, and several months later a much more prudent design of a 12 storey 800 bed hospital that will integrate into the existing 6 level 350 bed facility, that was my first few months...

i been in business myself... have loads of quals which align to nursing and management etc, as well as loads of varying experience, and while i speak just a smidgeon of chinese (not as much as i should for the amount of time here) i understand and have a great insight into the culture and their thinking... something not many laowais (foreigners) in china have. also i am blessed that i know as much as i do about many aspects of the culture, from business, what really goes and why to personal relationships etc. im sure i could write a thesis and get a PhD, or even a DHSc in the healthcare arena

the way healthcare works here is not the way it works in the west for a variety of reasons, and understanding the chinese psyche and guanxi are key to this.

its an interesting phenomena, when one considers that generally Dr's are paid around the same as nurses, therefore a hospital here has almost as many Drs as nurses, Drs will make up the difference in monetary terms though in more unique hidden ways (which everyone knows but no one discusses). nurses dont provide comprehensive (wholistic) nursing care (they don't bathe or toliet patients' as a rule) these are things family members will do. hospitals don't provide meals for patients, families buy food and bring it in. Drs (and nurses) perform procedures with much higher frequency than we do in the west and are therefore in some ways much more highly skilled, although perhaps they aren't in line with current best practice standards, but given that healthcare was so much more behind 10yrs ago (as i keep getting reminded) and chinese have developed so rapidly compared to us "westerners" or developed nations... i would expect that they will align themselves and then surpass us in another 10yrs.

while my position is somewhat unique in many ways, with my package being worth a fair amount... more money than i could earn just nursing in NZ or aussie (actually its on a par with what i got in saudi), but here i got a new car provided, an expense account & other reimbursements paid monthly, a huge exclusive 4 bedroom villa fully furnished instead of the typical apartment complexes, alot of business (guanxi) luncheons and dinners...

its hard though on a number of different levels, in ways that most would not understand nor believe ...things do move quite slowly, and its hard when the staff in general don't have any other experiences or knowledge, and i cant swap out my eyes nor brain matter to give them that insight... and that is frustrating!

so yes i (along with many others) will make some headway, some impact on healthcare in china in the intermediate to long term, but its a long tediously slow road (frustratingly so!)

consider a few intersting facts (sic)... this is a unique country, developing and changing very rapidly, much faster and with more haste than any other country has done in the past. its the most heavily populated, with 1.3 billion ppl. during the main annual holiday which is late jan-early feb (chinese new year/spring festival) the number of ppl moving at that time withing china is the greatest internal mass movement of ppl so much so that it alters the earth axis/tilt. china has the highest GDP of all countries. it has the 2nd highest amount of forex after the U.S. and china will become the most powerful country economically and strategically thereby becoming the superpower of the 21st century, actually within the next 10years. mandarin is the language that has the highest number of speakers, of all languages, and it will be a must know language for school leavers within the next 10-20yrs.

ok so i got a little sidetracked there for a moment, but well theres so much to write...

globalnurse · Apr 16, 2006

Aren't SA hospitals held to JCAHO standards or the Canadia standards? If you've been to SA and worked there wouldn't their P&P's be a good resourse.
As an aside, and not to change the subject, is China doing Hemodialysis? You may PM me so as not to clutter up this thread if you want.
More of a curiousity than anything.
Good luck. Seems like you have a hugmegous task ahead of you.

Hi there NephroBSN :)

First up whats SA? Does SA stand for South Africa? or South America? or am I to assume you mean South Asia? If you are, then I'm afraid you're somewhat misinformed, there is no legal requirement for South Asia to use or abide by JCAHO or Canadian standards of for such standards having presidence in this region. Another point to bear in mind is that the South Asia region is made of several countries, and therefore each country has its own medicolegal legislation in place. Notwithstanding that even though China as part of South Asia embraces others standards (particuarly those from Developed Nations) there are standards in place and required by various organs beginning with the Ministry of Health at the Central Govt. level trickling all the way thru each subordinate level of govt.

To answer your question. Yes China is doing Hemodialysis.

Perhaps you could do a websearch on China, I'm sure you'd be pleasantly surprised. For instance, to see a specialist consultant here, one does not need to go thru a GP or other such MD first. One simply arrives at the nearest Hospital pays the equivalent of US$0.30-0.50 for the consultation at a cashier window, then go sees the specialist at the Outpatients Dept. There are no waiting lists in the sense like most developed countries have.

Moreover, we recently worked up a young 9y.o. female (from the USA living here with her parents) to do a adenoidectomy with a whole host of special extras (like extended Hospital stay [as its not done as an Outpatient procedure here], VIP room etc.) the cost was at most $1000.

...interesting stuff...

globalnurse · Apr 28, 2006

hi there folks...

just an update... pulling together loads of policy/procedure/protocols... takes time to review them, format and translate them into draft formats...

still after some triage algorithms sets... both for ED/ER and prehospital care (as we also house the ambulance services.

anyone got a great link to something like manchester triage algorithms that i can download? I had a great set when i worked in saudi arabia, never thought to bring them here (darn it)

:idea:

pineapple lump · Sep 6, 2006

What a fantastic journey you've had. Just think of the wonderful feeling of achievement when it's done:bow: You said you worked at Saudi Aramco...they do have a web site...and are JCAHO certified. Worth looking into. I worked in Saudi for 7yrs and they did have very up to date Policy & Procedures, also JCAHO standards.

RGON...Reg.General & Obstretic Nurse.

globalnurse · Sep 7, 2006

What a fantastic journey you've had. Just think of the wonderful feeling of achievement when it's done:bow: You said you worked at Saudi Aramco...they do have a web site...and are JCAHO certified. Worth looking into. I worked in Saudi for 7yrs and they did have very up to date Policy & Procedures, also JCAHO standards.
RGON...Reg.General & Obstretic Nurse.

Hi there... fellow kiwi RN.

I'm constantly amazed that one can use this medium in ways beyond that of the phone to communicate almost anywhere. It's mind boggling if one stops to think about how rapid this form of communication has taken off in such a short time frame :rolleyes:

anyway, yes I was involved with Saudi ARAMCO but as a subcontractor, not a direct hire. Saudi ARAMCO don't hire that many males esp. in Nursing. That aside my role within the greater scheme of things was a very unique part of Saudi ARAMCO healthcare, as it was for a special project called RAC Project (Remote Area Clinics) as an educator. Basically I along with a few other male RN's and Paramedics would look after the educational needs of Nurses, Drs and other allied healthcare staff for the company that has staffing/supply contracts with Saudi ARAMCO. Unfortunately as anyone who has been a subcontractor vs a direct hire with Saudi ARAMCO can attest, there is various forms of discrimination exerted by the company, both directly and indirectly. In some respects the company I contracted to had a unique & somewhat better relationship with Saudi ARAMCO as a subbie, though there were still this "us and them" attitudes from time to time. IMO.

As for integration of JCAHO & the clinics/rigs that the RAC project handles, the RAC's aren't part of that accreditation though it was considered and even attempted while I was with the project. It's more to do with the RAC project and its reporting line and how its fits into Saudi ARAMCO Healthcare structure overall than any reflection on not meeting the standards, that saw the RAC project being taken out of the last accreditation cycle in 2005.

Anyways Pinnapple Lump... do I take it you're back in NZ? and if so what do you do now? and did you make your fortune in Saudi w Saudi ARAMCO? afterall 7yrs is a long time to make hay... :wink2: I was a little envious of all the benefits that Saudi ARAMCO healthcare employees got compared to us subbies on the outside... :uhoh21:

marcelinho · Jul 31, 2010

hi! were you sucesfull in finding hospital administration manual, manchester triage algorithms, emergency procedure flipcards? if yes, can you help me find them? thank you

Fonenurse... thanks for the post. appreciate it. have had a few responses by email and have followed up with several leads. a few other good sites have included: http://www.unchealthcare.org for a full range of nursing practice manuals, protocols and procedures
www.apic.org was ideal for infection control policies and procedures
http://www.healthsystem.virginia.edu/internet/infection-control/ic-manual.cfm also useful infection control policies & procedures
http://www.ha.org.hk also very useful infection control policies & procedures which also has some english/chinese translations (since being for a healthcare provider group in HK
these are just some of what i have found thus far.
i'm still after a Hospital Administration Manual (also known as a Manual of Hospital Administration), also a Manchester Triage Algorithms and a set of Emergency Procedure Flipcards... "code red for fire, code black for bomb threat etc, code blue for heart attack etc..."